Acupuncture is one of the most popular alternative therapies. It can be described most simply as the insertion of needles into the skin at specific points in order to treat disease or promote good health.

Used in many NHS practices, particularly pain clinics, acupuncture is acquiring increasing respectability. A UK regulatory body is being considered. The British Acupuncture Council (BAcC) exists for the non-medically qualified and the British Medical Acupuncture Society (BMAS) for doctors.[1] Training courses vary from a few weekends up to two years. Chinese training lasts six to ten years.

Related techniques include acupressure, auricular acupuncture, electroacupuncture, reflexology and shiatzu.

Origins

Archaeological evidence suggests that acupuncture was practised in the Stone and Bronze Ages. Used in China for over 3,500 years, the first textbook was the Yellow Emperor’s Classic of Internal Medicine (Huang Di Nei Jing Su Wen) around 500 BC, followed by The Classic of Acupuncture (259 AD).[2]

Persisting as part of traditional Chinese medicine for centuries, it was challenged by western medicine during the early twentieth century but reaffirmed by the communists in the 1950’s. It was introduced into Europe in 1683 by Willen Ten Rhijne, a Dutch physician.[3] It was first mentioned in the Lancet in 1823 as a treatment for rheumatism.[4] It has been at the forefront of the recent surge of interest in CAM (Complementary and Alternative Medicine).

Principles and practice

The philosophy and principles of Chinese acupuncture are based on Taoism, incorporating its concept of life force or ch’i (qi) that pervades all things, animates all life and flows freely through the body in normal health. It has two components, yin (negative force) and yang (positive force). The ch’i circulates around the whole body but particularly through twelve main channels, termed meridians.

When ch’i is in balance, the body is healthy; if it is blocked or out of balance, ill health results. Needling specific points connecting to meridians restores energy balance. Around 365 regular points are described.

Intervention is usually by dry-needling the skin with solid needles (0.12 – 0.3 mm gauge) to depths of one to two millimetres (shallow needling) or five to 60 millimetres (deep needling). The needles may be manipulated and then withdrawn or left in situ for 30 minutes or more, sometimes accompanied by electrical stimulation or moxibustion, the burning of powdered mugwort plant around the needles. Presently, self-acupuncture is uncommon. Herbal remedies may also be advised. As foods are believed to be yin or yang in effect, dietary advice may be given.

In auricular acupuncture, specific points relating to the whole body are said to be represented on the ear but these cannot relate to the normal meridian positions.

Diagnosis in traditional Chinese acupuncture assesses the state of ch’i in the body and specific organs. This involves detailed inspection of the tongue and pulse, identifying up to 28 qualities (such as ‘empty’ and ‘floating’) in six pulses in each wrist.[5]

Medical checklist

Does it have a rational scientific basis?

There is no supporting scientific evidence for the existence of ch’i, life force or meridians.[6] They cannot be identified with anatomical, nervous or vascular channels. Attempts to localise acupuncture points by histological examination have failed and electro-physical investigations have been inconclusive.

Western medical acupuncture

Attempting to distance itself from Taoist roots, a western version has evolved based on three theories:

1. The gate control of pain theory suggests that insertion of needles can modify the sensation of pain by closing a ‘pain gate’ in the nervous system.[7] This stops pain sensations passing up the nervous system whilst the ‘gate is closed’ in response to the needling. This is traditional counter-irritation, as when using kaolin poultices.

2. The opioids theory suggests that endogenous analgesics (such as endorphins) are responsible for acupuncture’s efficacy.[8]

3. Myofascial trigger points. It was believed that these were points of fibrositis or other painful soft tissue or rheumatic conditions. However, their existence and significance is in doubt. Their possible correlation with acupuncture points is being researched but no definite evidence has emerged.[9]

Whilst there may be scientific validity in these theories, much more research is needed. Significant evidence would emphasise the gap between the rituals of traditional Chinese acupuncture and western therapy.

Does it work?

Acupuncture is probably the most researched of all alternative therapies. It is therefore surprising that there is little convincing evidence for its efficacy. Acupuncture research is complex, particularly regarding the provision of a credible placebo in randomised controlled trials. ‘Sham acupuncture’ employs a Steitberger needle or Park Sham Device: the point is withdrawn into a hollow needle without skin puncturing.[10]

An in-depth investigation indicated possible benefit in dental pain, low back pain, nausea and vomiting but there was inconclusive or completely negative evidence in a wide range of other conditions reviewed.[11,12] These findings were confirmed by a ten-year assessment of systematic reviews, meta-analyses and random controlled trials in the Department of CAM at Exeter University. ‘Close to 100% of pain sufferers benefited from “sham acupuncture”.’[13] Rather than showing specific efficacy for real acupuncture, many of the results indicated that both real and sham acupunctures were good placebos. ‘…minimal acupuncture is easily incorporated into primary care consultations but there is no convincing evidence for its effectiveness’.[14]

Is it safe?

It is a popular myth that acupuncture is safe. At least 50 fatalities have been recorded from lung, cardiac and nervous complications.[15]

Acupuncture hazards

• Incorrect or delayed diagnosis
• Local reactions: pain, bruising, infection, and haematoma
• Moxibustion burns
• Trauma: pneumothorax, cardiac tamponade, spinal cord and peripheral nerve damage
• Retained needles
• Systemic illness: hepatitis, endocarditis, septicaemia, osteomyelitis, auricular perichondritis and HIV
• Fainting and post treatment drowsiness

The incidence of adverse effects is around one in 10,000-100,000. A Norwegian survey reported that 30% of acupuncturists and 12% of doctors noted adverse effects.[16] A recent paper reported five adverse reactions including a fatal case of pneumothorax and cardiac tamponade.[17]

Christian checklist

There is no real dispute that traditional Chinese acupuncture is rooted firmly in the Taoist religion with its concepts of ch’i, yin yang and Universal Life Force. Tao means ‘The Way’. The Yellow Emperor explains: ‘Yin Yang is the way (Tao) of heaven and earth, the principle of everything, the parents of all changes, the origin of life and death, the palace of god. Healing of diseases requires the seeking of the origin…’[18]

This is quite foreign to biblical Christian teaching and faith in a personal sovereign Creator God and heavenly Father.

Western acupuncture seeks to distance itself from these beliefs and engage with the scientific. Despite the sincerity of those who attempt this, I believe the gap is too wide and leads to confusion and compromise.

Conclusion

Despite considerable research, no compelling evidence has been established for acupuncture’s effectiveness and safety concerns cannot be ignored. The Christian carer’s attitude to acupuncture must reflect integrity, respect truth and reject life and faith principles based on a non-Christian belief system. Consequentially, this precludes the use of traditional Chinese acupuncture and careful biblical discernment is required when considering the use of western acupuncture.

Prove all things; hold fast that which is good. Abstain from all appearance of evil. (1 Thessalonians 5:21-22 KJV)

Jesus said, ‘I am the way, the truth and the life’. (John 14:6 KJV)